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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Benefit of extracorporeal membrane oxygenation in myocardial infarction-induced cardiogenic shock
Julian F Wagner1, Hannes Abfalterer2, Cenk Özpeker2
1Department of Anesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria - julian.wagner@i-med.ac.at.
Insights
Extracorporeal membrane oxygenation (ECMO) significantly improves survival for patients with acute myocardial infarction (AMI)-induced cardiogenic shock (CS). This study found ECMO support increases survival probability 2.57-fold, recommending it as a first-line treatment.
Area of Science:
- Cardiology
- Critical Care Medicine
- Cardiovascular Surgery
Background:
- Acute myocardial infarction (AMI)-induced cardiogenic shock (CS) is a critical condition requiring immediate support.
- Extracorporeal membrane oxygenation (ECMO) is a vital emergency support for various cardiogenic shock etiologies.
- No prior controlled studies have investigated ECMO's efficacy in AMI-induced CS.
Purpose of the Study:
- To evaluate the effectiveness of ECMO in patients experiencing cardiogenic shock due to acute myocardial infarction.
- To compare survival rates between patients with AMI-induced CS treated with and without ECMO.
- To identify predictors of long-term survival in AMI-induced CS patients.
Main Methods:
- Retrospective analysis of 476 patients with AMI-induced CS.
- Comparison of outcomes between 127 patients receiving veno-arterial ECMO and 349 patients not receiving ECMO.
- Propensity score matching to create 127 matched pairs for robust comparison.
Main Results:
- ECMO group showed significantly higher 1-, 3-, and 5-year survival rates (45.6%, 43.5%, 41.3%) compared to the unmatched control group (17.4%, 15.8%, 14.9%).
- After propensity score matching, ECMO was associated with improved survival (log-rank P<0.001).
- ECMO support (HR: 2.57) and complete revascularization (HR: 1.89) were independent predictors of long-term survival.
Conclusions:
- Extracorporeal membrane oxygenation (ECMO) significantly enhances survival in patients with acute myocardial infarction-induced cardiogenic shock.
- ECMO therapy should be strongly considered as a first-line treatment for profound AMI-induced CS.
- The study highlights ECMO's critical role in improving outcomes for this high-risk patient population.
Background:
Extracorporeal membrane oxygenation (ECMO) is frequently used for emergency support in patients with profound cardiogenic shock (CS) of all etiologies. However, no controlled study investigating ECMO in myocardial infarction (AMI)-induced CS is available.
Methods:
Retrospective analysis of patients experiencing AMI induced CS; ECMO therapy vs. non ECMO therapy. A total of 476 patients with AMI-induced CS were investigated. One hundred twenty-seven patients (26.7%) received emergency veno-arterial ECMO support, 349 patients did not receive ECMO support. Patients were propensity score matched based on relevant clinical and laboratory factors and revealed 127 matched pairs.
Results:
Mean age of patients was 65.0±12.3 years and mean Syntax score was 25.9±7.3 in the full unmatched patient population. Survival at 1, 3 and 5 years after CS was 45.6%, 43.5%, and 41.3% in the ECMO group and 17.4%, 15.8%, and 14.9% in the full unmatched control group (log-rank: P<0.001). After propensity score matching, 1-, 3-, and 5-year survival was 14.4%, 13.5%, and 11.2% in the matched control group (P<0.001). Cox regression analysis identified ECMO support (HR: 2.57; 95% CI: 1.89-3.50; P<0.001) and completeness of revascularization (HR: 1.89; 95% CI: 1.74-2.34, P=0.003) to be independent predictors for long term survival.
Conclusions:
Extracorporeal life support by ECMO significantly increased survival in patients with AMI-induced CS. ECMO insertion increased survival probability 2.57-fold and should be considered as first line treatment in patients with profound AMI-induced CS.
